ICAP, Columbia University, New York, New York, USA.
Int J Tuberc Lung Dis. 2013 Sep;17(9):1178-85. doi: 10.5588/ijtld.12.0823.
To assess the effectiveness of a peer-based intervention on adherence to and completion of latent tuberculous infection (LTBI) treatment.
Patients prescribed self-administered LTBI treatment were enrolled in a randomized controlled trial of an experimental, peer-based adherence support intervention. Primary outcomes were treatment adherence and completion. Adherence was assessed through self-report, electronic monitoring devices and clinic visits.
Of 250 participants, 70% were male; 71% were Black and 20% Latino; the mean age was 40 years; 67% were foreign-born and 39% were married. No significant baseline differences were noted between the intervention groups. Treatment completion was 61% in the intervention group compared to 57% in the controls (P = 0.482). The corresponding completion rate for other clinic patients was 44%. Foreign birth, marriage and history of mental illness were associated with non-completion of treatment after controlling for the intervention group; increased completion rates were found among foreign-born married persons and older participants. A substantial difference in adherence rates was observed between the intervention groups. Adherence among non-completers decreased early, while adherence among completers remained constant.
The peer-based intervention was not significantly associated with LTBI treatment completion, but was associated with greater adherence. Findings suggest the importance of interventions to support adherence that target early non-adherence with LTBI treatment, particularly in the first 2 months, when there is a substantial risk of default.
评估基于同伴的干预措施对潜伏性结核感染（LTBI）治疗的依从性和完成率的效果。
接受自我管理 LTBI 治疗的患者参加了一项实验性基于同伴的依从性支持干预的随机对照试验。主要结局是治疗的依从性和完成率。通过自我报告、电子监测设备和就诊来评估依从性。
在 250 名参与者中，70%为男性；71%为黑人，20%为拉丁裔；平均年龄为 40 岁；67%为外国出生，39%为已婚。干预组之间没有显著的基线差异。干预组的治疗完成率为 61%，对照组为 57%（P=0.482）。其他就诊患者的相应完成率为 44%。控制干预组后，外国出生、婚姻和精神病史与治疗完成相关；外国出生的已婚人士和年龄较大的参与者的完成率增加。干预组之间的依从率存在显著差异。未完成治疗者的依从率早期明显下降，而完成治疗者的依从率保持不变。
基于同伴的干预措施与 LTBI 治疗完成率没有显著相关，但与更高的依从性相关。研究结果表明，需要干预措施来支持依从性，特别是在头 2 个月，患者存在很大的脱失风险，此时需要针对 LTBI 治疗的早期不依从进行干预。
